Provider Demographics
NPI:1700073194
Name:VICTORY REHABILITATION AND HEALTHCARE CENTER, LLC
Entity type:Organization
Organization Name:VICTORY REHABILITATION AND HEALTHCARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-937-7994
Mailing Address - Street 1:510 N PARKWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-8004
Mailing Address - Country:US
Mailing Address - Phone:360-687-5141
Mailing Address - Fax:360-687-1897
Practice Address - Street 1:510 N PARKWAY AVE
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-8004
Practice Address - Country:US
Practice Address - Phone:360-687-5141
Practice Address - Fax:360-687-1897
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORIANNA HEALTH SYSTEMS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-28
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1406314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4114062Medicaid
WA4114062Medicaid